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. 2025 Aug;52 Suppl 29(Suppl 29):34-57.
doi: 10.1111/jcpe.14170. Epub 2025 May 7.

Evaluating the Performance and Implementation of the 2018 Classification of Periodontal Diseases: A Systematic Review and Survey

Nicola X West  1 , Alexander Gormley  1 , Alexander J Pollard  1 , Rossana Izzetti  2 , Crystal Marruganti  3 , Filippo Graziani  2
Affiliations

Evaluating the Performance and Implementation of the 2018 Classification of Periodontal Diseases: A Systematic Review and Survey

Nicola X West et al. J Clin Periodontol. 2025 Aug.

Abstract

Aim: To evaluate the performance and implementation of the 2018 Classification of Periodontal Diseases for periodontitis through systematic review and survey methodology.

Materials and methods: A two-part systematic review was conducted. Part 1 aimed, with descriptive statistics, to evaluate performance metrics of the 2018 Classification, including diagnostic accuracy, prognostic performance and examiner reliability. Part 2 used thematic analysis to elucidate facilitators and barriers to the implementation of the classification. A survey collected evidence of barriers, facilitators and local implementation.

Results: Part 1 of this review included 14 individual studies of moderate risk of bias. Eight studies examined diagnostic accuracy, three studies examined prognostic efficacy and three studies examined inter-/intra-rater reliability. Part 2 included 33 individual studies with data considered at high risk of bias. The survey returned 1113 responses. The thematic analysis in Part 2 led to seven findings, five related to facilitators and two concerning barriers to the implementation. Survey results showed that 78% of respondents currently use the classification, but the most common concerns relate to its complexity.

Conclusions: The 2018 Classification performs well as a classification in comparison with previous classifications. Specific identified barriers have potentially limited the comprehensive uptake of the classification.

Keywords: diagnosis; epidemiology; periodontal diseases; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA diagram, as generated by Haddaway et al. (2022).
FIGURE 2
FIGURE 2
PRISMA diagram, as generated by Haddaway et al. (2022).
FIGURE 3
FIGURE 3
Age of respondents.
FIGURE 4
FIGURE 4
Respondent's reported base country.
See this image and copyright information in PMC

References

    1. Aboalsaud, K. M. , Foster N. L., Yu S.‐H., Sweier D. G., and Rulli D.. 2023. “Periodontal Staging and Grading: An International Dental Hygiene Education Survey.” International Journal of Dental Hygiene 21, no. 2: 283–290. - PubMed
    1. Abrahamian, L. , Pascual‐LaRocca A., Barallat L., et al. 2022. “Intra‐ and Inter‐Examiner Reliability in Classifying Periodontitis According to the 2018 Classification of Periodontal Diseases.” Journal of Clinical Periodontology 49, no. 8: 732–739. - PMC - PubMed
    1. Alawaji, Y. N. , Alshammari A., Mostafa N., Carvalho R. M., and Aleksejuniene J.. 2022. “Periodontal Disease Prevalence, Extent, and Risk Associations in Untreated Individuals.” Clinical and Experimental Dental Research 8, no. 1: 380–394. - PMC - PubMed
    1. Altman, D. G. , and Altman E.. 1999. Practical Statistics for Medical Research. Springer London, Limited.
    1. Arias‐Bujanda, N. , Regueira‐Iglesias A., Balsa‐Castro C., Nibali L., Donos N., and Tomás I.. 2020. “Accuracy of Single Molecular Biomarkers in Saliva for the Diagnosis of Periodontitis: A Systematic Review and Meta‐Analysis.” Journal of Clinical Periodontology 47, no. 1: 2–18. - PubMed

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